Job Description for Customer Service Representative
Reports to: RCM Manager
FLSA Status: Non-Exempt
Job Summary: Provides the billing department with day-to-day support in collections, data entry, customer service, cash posting, and reporting.
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Primary Job Duties:
Review, process, edit, and approve claims for filing either electronically or on paper.
Investigate claim denials, pull supporting data from patient medical records/EMR and billing system, and work with payers to resolve issues related to outstanding claims.
Assist with posting insurance payments, denials, and adjustments.
Review accounts receivable and follow-up with patients and insurance companies on outstanding balances and documents follow-up appropriately.
Answer patient calls and written correspondence related to billing.
Provide support to the front end staff on billing issues.
Assist the front desk staff when needed including covering during busy times.
Demonstrate ongoing competency and proficiency in job requirements.
Attend staff meetings as scheduled.
Maintain strictest confidentiality.
Other duties as assigned.
Education:
High school diploma or equivalent
Licenses/Certifications:
NA
Experience:
Two years experience in medical billing systems, medical coding, and basic medical terminology required.
Knowledge:
Familiarity with medical billings systems, medical coding and basic medical terminology.
Competent with common PC applications including Internet, Email and Microsoft Office.
Skills:
Ability to communicate clearly and effectively.
Ability to multi-task and prioritize work load.
Detail oriented with excellent communication skills.
Excellent Customer Service skills required.
Ability to interpret and uphold policies and procedures.
Type 30 words per minute with 95% accuracy.
QUALIFICATIONS FOR THE JOB
Education:
1. A minimum of five (5) years experience in medical office environment is preferred.
2. Advanced working knowledge of billing operations, including charges, coding, payment, insurance claims and appeals.
3. Current knowledge of CPT, HCPCS and ICD-10-CM coding.
4. Working knowledge of methods, procedures, regulations and guidelines in patient and payer billing.
5. Current knowledge of insurance payer coding and reimbursement guidelines.
6. Working knowledge and experience in health information system management, including billing and medical record applications as well as claims clearinghouse.
7. Proficient organizational skills, attention to detail and accuracy.
8. Demonstrated ability to establish and maintain effective working relationships with internal and external parties.
9. Excellent interpersonal and communication skills to foster collaboration.
10. Ability to project a professional image.
11. Demonstrates critical thinking skills. Thinks independently, professionally, and ethically.
12. Knowledge of regulatory standards and compliance requirements in addition to departmental policies and procedures.
13. Working knowledge and ability to apply professional standards of practice in job situations.
14. Maintain appropriate professional composure in high stress situations.
15. Working knowledge of personal computer and software applications used in job functions.
Experience:
1. Proficient organizational skills, attention to detail and accuracy.
2. Demonstrated ability to establish and maintain effective working relationships with internal and external parties.
3. Excellent interpersonal and communication skills to foster collaboration.
4. Ability to project a professional image.
5. Demonstrates critical thinking skills. Thinks independently, professionally, and ethically.
6. Knowledge of regulatory standards and compliance requirements in addition to departmental policies and procedures.
7. Working knowledge and ability to apply professional standards of practice in job situations.
8. Maintain appropriate professional composure in high stress situations.
9. Working knowledge of personal computer and software applications used in job functions.
10. Able to communicate effectively in English, both verbally and in writing.
11. Excellent customer service skills.
12. Additional languages preferred.
Other:
1. Excellent computer knowledge and skills in working with spreadsheets, data entry, internet/intranet, etc.
2. Ability to use all office equipment.
3. Able to type 60-70 words per minute, accurately.
KEY COMPETENCIES
Sterling Medical's billing specialist will have strong communication and interpersonal skills. As a billing specialist, interaction will be with a variety of individuals to include patients, health insurance providers, other healthcare providers and other members of the healthcare team. Difficult conversations are part of their work day. The billing specialist always remains patient and courteous in difficult times.
The ideal billing specialist should be good at solving problems. They should have an analytical mind with an eye that provides keen attention to detail. They should be fluent with procedures in processing claims to ensure timely and accurate payment for services provided.
Integrity is important for Sterling Medical’s billing specialist. They will be working with patient’s personal information and health information regularly. They should have accurate knowledge on HIPAA regulations and practice confidentiality at all times. They also need to be aware of payer regulations and ensure compliance.
Dependability is key for Sterling Medical’s billing specialists because they may work outside of the clinic environment and they are the ones that ensure the healthcare provider is paid for services they provide and in-turn; ensure cash is coming into the practice.
As a key support staff, Sterling Medical's Billing Specialist must work well within a team environment and be able to support their colleagues.
